SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC - NPI NUMBER 1124282462

Summary

Provider Name: SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC

NPI Number: 1124282462

Clasification: Internal Medicine (207RP1001X)

Specialization: Pulmonary Disease

Address:
317 S 14TH ST
SUITE 3
HERRIN, IL
ZIP 62948

Phone Number: (618) 942-7402



Detailed Information

SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC is a pulmonary disease internist in Herrin, IL. The provider is an internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. The assigned NPI number for this provider is 1124282462 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

317 S 14TH ST
SUITE 3
HERRIN, IL
ZIP 62948-671
Phone: (618) 942-7402

The provider's authorized official is Suhail Istanbouly .
The authorized official title is President and has the following contact phone number (618) 942-7402.

The enumeration date for this NPI number is 7/16/2008 and was last updated on 11/4/2008.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1144407131 SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
Internal Medicine (Pulmonary Disease)
1396775581 SHAWNEE HEALTH SERVICE DEVELOPMENT CORP
Internal Medicine (Pulmonary Disease)
1841262789 DR. RAYMUND O PINEDA, M.D.
Internal Medicine (Pulmonary Disease)
1073826269 SAREER ZIA, MD
Internal Medicine
1144395633 A PRAMOTE MD SC
Internal Medicine
1184822371 DR. SHANNON HOPEN, D.O.
Internal Medicine
1144517996 SIVA PARCHA, MD
Internal Medicine





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207RP1001X Internal Medicine Pulmonary Disease 036098950 IL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 217038 MEDICARE PIN IL
2 036098950 MEDICAID IL

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1124282462 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 317 S 14TH ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE 3 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name HERRIN The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name IL The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 629483671 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 6189427402 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 7/16/2008 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 11/4/2008 The date that a record was last updated or changed.
14 Authorized Official Last Name ISTANBOULY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name SUHAIL The first name of the authorized official.
16 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
17 Authorized Official Telephone Number 6189427402 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 207RP1001X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 036098950 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 217038 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 IL
25 Other Provider Identifier 2 036098950 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 2 IL
28 Is Organization Subpart N
29 Authorized Official Name Prefix Text DR.
30 Authorized Official Credential Text M.D.
31 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 2/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.